HIV and Opportunistic Infections, Coinfections, and Conditions

Human papillomavirus (HPV) is a common virus spread through intimate skin-to-skin contact. There are many types of HPV that can be split into two main categories:

• Low-risk HPV, which can cause oral, anal, and/or genital warts
• High-risk HPV, which can cause different kinds of precancers (abnormal cells that could lead to cancer) and cancer, such as cervical, vaginal, vulvar, penile, anal, and oropharyngeal (back of the throat)

People with HIV are more likely to acquire both kinds of HPV.

HPV is considered a sexually transmitted infection. You can get HPV by having vaginal, anal, or oral sex with someone who has the virus, even if they do not show any signs or symptoms. A person can have HPV for years without experiencing symptoms. For more information on sexually transmitted infections, see the HIVinfo fact sheet HIV and Sexually Transmitted Diseases.

Both HIV and HPV can be spread through sexual activity. Behaviors that put people at increased risk for HIV also increase their risk for HPV and other sexually transmitted infections. These behaviors include the following:

• Having sex without a condom
• Having sex with many partners, especially anonymous partners
• Having sex while using drugs or alcohol.

Since HIV targets the immune system’s infection-fighting CD4 cells (CD4 T lymphocyte), it is more difficult for the body to fight off infections and illnesses. HPV is an opportunistic infection, meaning that people with HIV are more likely to acquire HPV. Compared to people without HIV, people with HIV may have larger or more numerous warts and are more likely to develop HPV-associated warts, precancers, and cancers.

For more information on opportunistic infections, see the HIVinfo fact sheet What is an Opportunistic Infection?

Get vaccinated.

The HPV vaccine can protect against many disease-causing types of HPV. Getting the HPV vaccine can reduce your risk of getting genital warts and developing precancers and cancers.

CDC recommends that people with HIV, starting at age 9, can receive the HPV vaccine. People with HIV usually receive 3 doses of the vaccine over a 6-month period. The HPV vaccine is most effective administered before a person is sexually active or exposed to the virus.

For information on other immunizations, see the HIVinfo fact sheet HIV and Immunizations.

Protect yourself during sex.

If you are sexually active, reducing the number of people you have sex with and avoiding sexual activity with people who have had many sexual partners can reduce your risk of getting HPV. Using condoms correctly every time you have sex can also reduce the risk of getting HPV and other STIs. Visit Centers for Disease Control and Prevention (CDC) to learn how to use condoms correctly.

Detecting cancer at an earlier, more curable stage can mean more effective treatment. Therefore, the NIH recommends that people with HIV (even those who have been vaccinated) undergo regular anal screening and cervical cancer screening.

Anal Cancer Screening

All adults with HIV should be assessed for anal abnormalities (such as pain, burning, or masses) and undergo a digital anorectal exam (DARE) annually. During a DARE, your health care provider will examine the outside of the anus and use a gloved, lubricated finger into the rectum to check for any abnormal findings. If there are abnormal findings, anal cells are collected and checked for signs of precancer or cancer.

The age at which anal screening should start depends on their individual risk. Most people with HIV should start anal cancer screening at age 45. Others, such as men who have sex with men and transgender women, are at increased risk of anal cancer and should begin anal cancer screening starting at age 35.

Cervical Cancer Screening

Once a person who is age 21 years or older is diagnosed with HIV, they should undergo annual cervical cancer screening, which can include an HPV test to determine the type of HPV involved and a Pap smear to collect and check cervical cells for signs of precancer or cancer. If signs of precancer or cancer or high-risk HPV are found, your health care provider may need to do additional testing, such as a colposcopy to examine the cervix, vagina, and vulva more closely.

Factors such as age and test availability impact what tests are used.

There is no treatment for HPV infection specifically, but there are treatments for HPV-associated warts, precancers, and cancers.

Genital or oral warts can be treated with ointments or gels at home or by surgery or cryotherapy (freezing) in a clinic, depending on their location, size, and number.

Precancers can be removed, lasered, or frozen before they become cancer.

Cancer treatment can involve surgery, chemotherapy, and/or radiation.

People with HIV receive treatment for warts, precancers, and cancers similar to those without HIV.